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. 2024 Aug 1;154(Suppl 1):e2024066588G.
doi: 10.1542/peds.2024-066588G.

Efficacy of Antibiotic Regimens for Pneumonia in Young Infants Aged 0-59 Days: A Systematic Review

Krysten North  1   2 , Alejandro Frade Garcia  3 , Mark Crouch  4 , Spencer Kimsen  4 , Amber Hoey  5 , Carrie Wade  2 , Yumin Kim  6 , Roger Chou  7 , Karen M Edmond  8 , Anne C C Lee  1   2 , Chris A Rees  9
Affiliations

Efficacy of Antibiotic Regimens for Pneumonia in Young Infants Aged 0-59 Days: A Systematic Review

Krysten North et al. Pediatrics. .

Abstract

Context: Pneumonia is a leading cause of death in young infants.

Objectives: To evaluate the efficacy of different antibiotic regimens to treat young infant pneumonia on critical clinical outcomes.

Data sources: MEDLINE, Embase, CINAHL, World Health Organization (WHO) Global Index Medicus, Cochrane Central Registry of Trials.

Study selection: We included randomized controlled trials of young infants aged 0 to 59 days with pneumonia (population) comparing the efficacy of antibiotic regimens (intervention) with alternate regimens or management (control) on clinical outcomes.

Data extraction: We extracted data and assessed risk of bias in duplicate. We used Grading of Recommendations, Assessment, Development, and Evaluation to assess certainty of evidence.

Limitations: Trials were heterogeneous, which precluded data pooling.

Results: Of 2601 publications screened, 10 randomized controlled trials were included. Seven trials were hospital-based (n = 869) and 3 were nonhospital-based (n = 4329). No hospital-based trials evaluated WHO-recommended first-choice regimens. One trial found the WHO-recommended second-choice antibiotic, cefotaxime, to have similar rates of treatment success as non-WHO-recommended regimens of either amoxicillin-clavulanate (RR 0.99, 95% confidence interval 0.82-1.10) or amoxicillin-clavulanate/cefotaxime (RR 1.02, 95% confidence interval 0.86-1.12). Among 3 nonhospital-based trials comparing oral amoxicillin to alternate regimens to treat isolated tachypnea among infants aged 7-59 days, there were no differences in treatment failure between amoxicillin and alternate regimens. Certainty of evidence was low or very low for all primary outcomes.

Conclusions: We found limited evidence to support the superiority of any single antibiotic regimen over alternate regimens to treat young infant pneumonia.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Ms Edmond is an employee of the sponsor, the World Health Organization. Dr Chou is the Grading of Recommendations, Assessment, Development, and Evaluation methodologist for the World Health Organization guidelines for management of severe bacterial infections in infants aged 0 to 59 days. The other authors have indicated they have no conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. From: Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
FIGURE 2
FIGURE 2
RoB graph: Review authors’ judgements about individual RoB items presented as percentages across all included studies.
See this image and copyright information in PMC

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